Abstract:There is a significant overall improvement in tissue perfusion of the foot immediately after tibial angioplasty. The effect shown in this study, however, was found to be global and was not restricted to certain borders, such as defined by angiosomes.
“…Similar results have already been reported when measuring the immediate changes of tissue perfusion after tibial angioplasty; in these previous studies, the impact of tibial angioplasty on the foot's skin microcirculation was investigated by laser doppler flowmetry and white light tissue spectrometry, with an overall improvement of the foot perfusion identified, but no difference recognised in directly and indirectly revascularised angiosomes. 15 Interestingly, in the present study, in a subgroup analysis of diabetic patients, the microcirculatory improvement in the directly revascularised angiosomes was elevated in comparison with the indirectly revascularised angiosomes. However, this finding in a small subgroup of 16 patients must be interpreted with caution and requires further evaluation in future larger cohorts, as the impact of the angiosome concept in diabetic patients is debatable.…”
Microcirculatory improvement was seen over the whole foot after tibial bypass. Therefore, fluorescence angiography is a promising tool to evaluate the angiosome concept in future larger studies. Clinicaltrials.gov: NCT03012750.
“…Similar results have already been reported when measuring the immediate changes of tissue perfusion after tibial angioplasty; in these previous studies, the impact of tibial angioplasty on the foot's skin microcirculation was investigated by laser doppler flowmetry and white light tissue spectrometry, with an overall improvement of the foot perfusion identified, but no difference recognised in directly and indirectly revascularised angiosomes. 15 Interestingly, in the present study, in a subgroup analysis of diabetic patients, the microcirculatory improvement in the directly revascularised angiosomes was elevated in comparison with the indirectly revascularised angiosomes. However, this finding in a small subgroup of 16 patients must be interpreted with caution and requires further evaluation in future larger cohorts, as the impact of the angiosome concept in diabetic patients is debatable.…”
Microcirculatory improvement was seen over the whole foot after tibial bypass. Therefore, fluorescence angiography is a promising tool to evaluate the angiosome concept in future larger studies. Clinicaltrials.gov: NCT03012750.
“…This technique is also used for periprocedural perfusion measurements in the foot following balloon angioplasty. Measuring perfusion in the foot angiosome following isolated crural measurement showed that there was no significant difference between direct and indirect revascularization on the microcirculatory level: on the contrary, an improvement in overall foot perfusion was seen following revascularization [13, 14]. Fig.…”
Critical limb ischemia (CLI) remains a challenge for an interdisciplinary therapeutic team due to chronic nonhealing wounds. Against this background, there is a necessity of quality control after revascularization. Beside the isolated evaluation of the macrocirculation by Ankle-Brachial or Toe-Brachial Index measurements, the microcirculation as an additional important factor of wound healing often remains underestimated. The following article gives an overview about the current investigation methods for noninvasive perfusion control of the CLI patient. Therefore, transcutaneous oxygen pressure (tcpO2), the “oxygen-to-see” method which is a combination of white light tissue spectrometry and laser-Doppler flowmetry, fluorescence angiography with indocyanine green, and multispectral optoacoustic tomography will be described.
“…True clinical application of the AC primarily implies thorough evaluation of the benefit allowed by targeted macroand microvasculature reperfusion [17] [27]. Effective flow mapping toward the wound zone ( Figure 1) [20] already revealed the clinical importance of foot arches in topographic reperfusion, while Osawa [19], Zheng [18], and Acin [55] [22]. The importance of the notion "mean-time to tissue recovery" appears then to be ponderous in defining real benefits of DR/WTR versus IR [17] [55].…”
Section: The Relevance Of Wtr In Current Vascular Practicementioning
confidence: 99%
“…A few contemporary studies add the WTR notion to DR, or to "DR-collateral enhanced" according to the AC [3] [10] [18] [19] as primary intention to treat CLTI. These studies reveal several observational advantages of this theory [10] [17] [18] [19] and obviously, some inherent uncertainties [20] [21] [22] [23].…”
Despite a lack of solid evidence in applying the angiosome concept (AC) in current chronic limb threatening ischemia (CLTI) treatment, several encouraging results for improved wound healing and less for limb preservation were reported in various consistency studies. Direct revascularization (DR) following the foot angiosomes distribution (whenever feasible) may afford better clinical results compared to angiosome indifferent, or indirect revascularization (IR), however without clear benefit on survival and for major adverse limb events (MALE). Inside this interrogation, the notable influence of the remnant collaterals, the foot arches, the wound characteristics, and the type of revascularization (bypass versus endovascular) still remain ardent topics. Current evidence suggests that applying DR in daily vascular practice requires practitioners to be committed to every individual hemodynamic variable in a thorough macro-and micro-vascular evaluation of the ischemic foot. It becomes clearer nowadays that not all CLTI foot ulcers hold same ischemic burden and seemingly need specific DR. In the same setting, a novel wound targeted revascularization (WTR) design was proposed assembling wider circulatory targets than genuine DR notion, as used by some authors. Beyond specific angiosomal artery reperfusion, WTR associates the available arches, the large-and medium-sized collaterals, and the arterial-arterial communicants, in an intentional "source artery" and "collateral" topographic foot revascularization. However, up to date, the notion of angiosome wound-guided revascularization (DR and WTR) detains only a reserved level of confirmation. As for DR, the WTR equally needs higher levels of evidence allowed by standardized definition, uniform indications, and pertinent results from multicenter larger prospective analysis, before large application.
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